Audits and Coding Quality Reviews

The OIG and CMS recommend “regular” reviews, but give no guidance as to frequency. We suggest that our clients establish an annual budgetary amount, and then stagger it in quarterly reviews instead of one large annual evaluation. The cost is the same and has three major benefits. First, the expense of the audit is spread throughout the year. Second, the providers and coders receive feedback on the status of the coding throughout the year. Third, a program of regular quarterly feedback provides an opportunity to correct the errors identified and then confirm that the corrective action has been effective without having to wait an entire year. If coding errors continue to occur, then a targeted plan of action can be instituted.

The implementation and operation of this program is quite simple. Periodically (monthly, quarterly, semi-annually, or annually) participating practices send us a representative sample of their visit notes, procedure reports and claim forms. We perform a government-style audit of the coding, using all available screens and regulations. We then send you a case-by-case analysis of our findings. Our medical coding and surgical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives our clients’ medical coders and surgical coders the feedback they need to more accurately code the patient-care services.

Have you been the target of a compliance audit? If you think you’re being treated unfairly, let us “audit the auditors.” Our findings can be your best defense!

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CPT 2018 Changes for Orthopaedic Surgery

January 15th, 2018|Comments Off on CPT 2018 Changes for Orthopaedic Surgery

CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost

By Heidi Stout, CPC, COSC, CCS-P

 

Not much will change for orthopaedic surgery coding in 2018.  Most of the changes in CPT 2018 to the Musculoskeletal […]

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Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

January 13th, 2018|Comments Off on Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler quality reporting system that would not be mandatory in […]

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Charleston dentist sentenced to five years in federal prison for health care fraud

December 18th, 2017|Comments Off on Charleston dentist sentenced to five years in federal prison for health care fraud

A Charleston dentist who falsely billed West Virginia Medicaid for more than $700,000 was sentenced today to 5 years in federal prison. Skaff, a dentist, admitted that he falsely inflated his billings (a practice commonly known as […]

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Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

November 5th, 2017|Comments Off on Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

On July 21st, 2017, Jahan Imani, M.D., and Intermountain Medical Management, P.C., (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. This resolves allegations that IMM, […]